Delivery 300 characters Additional notes about baby's death Date cannot be in the future and older than a month from today. Date of death Health facility Home Other Place of death - Parent Area Health Facility ID - - No Yes Was this a stillbirth? Death Information - Baby Alive and unwell Alive and well Select one. What is the condition of baby? Does the baby have any of the following danger signs? Each baby will be asked about individually. Baby Please enter a name for the baby to identify them in the app. You can change it later. Name Parent Area Health Facility ID Type Female Male Sex Should be between 35.6 cms and 70 cms. I don't know Length in cm Birth length Should be between 1500 grams and 5000 grams. I don't know Weight in grams Birth weight No Yes Blue skin color No Yes Were they initiated on breastfeeding within on hour of delivery? No Yes Is the child exclusively breastfeeding? No Yes Convulsions No Yes Difficulty feeding or drinking No Yes Drowsy or unconscious No Yes Fever Please counsel the family and refer the child to the nearest health center where the baby can be immunized. No Yes Infected umbilical cord No Yes Body stiffness BCG and Birth Polio BCG only Birth Polio only None Select one. What vaccines have they received? No Yes Vomits everything No Yes Yellow skin color Sections will repeat if multiple babies were delivered. Please fill out one section per baby. Baby's Condition Alive and unwell Alive and well Deceased What is the outcome for the woman? 's Condition If babies were delivered, you will have the chance to report on them Next >. After reporting a death, the person's profile will be locked. If reported in error, you may undo the death report from the profile. - Type - 300 characters Additional notes No Yes Did the woman deliver any babies before she died? Date cannot be in the future and older than a month from today. Date of death Health facility Home Other What was the place of death? - Death Information - Woman How many babies are alive? Can not be more than babies delivered. 1 2 3 Other How many babies were delivered? Select this only if more than 3 babies were delivered. Other Skilled health care provider Traditional birth attendant Who conducted the delivery? Maximum 100 characters allowed. Please specify other Date cannot be in the future and older than a month from today. Date of delivery Cesarean Vaginal How did she deliver? Health facility Home Other Where did delivery take place? Maximum 100 characters allowed. Please specify other Delivery Outcome What is the patient's name? Date of Birth Name Household ID Area ID CHW name CHW phone Contact Health Facility ID Parent Parent Parent Patient ID Sex Short Name Contact Source Source ID Contact ID Name Phone User Patient No Yes Convulsions No Yes Fever Does the woman have any of the following danger signs? No Yes Severe headache No Yes Vaginal bleeding No Yes Foul smelling vaginal discharge Postnatal Danger Sign Check - Woman Must be between 0 and 6. Any additional PNC visits, please report the number of visits below to be counted in the total. Which PNC visits have taken place so far? The WHO recommends PNC visits within 24 hours and on 3 days, 7 days, and 6 weeks from date of delivery. PNC Visits Lactating mothers need to eat more than usual to feed their baby well. Ask the woman to eat a variety of foods, especially extra fluids, fruits, and vegetables. For the first 6 months, give the baby breastmilk only. To keep the baby warm, use kangaroo mother care, wrap the baby with clothes and cover the head, and keep the baby in a warm room. Always sleep with the baby under a long-lasting insecticide treated net (LLIN). Keep the baby's umbilical cord clean and dry. Safe Postnatal Practices the woman Woman Health facility Home Other Health facility Home Other Number of babies deceased: Number of babies delivered: Deceased Alive and unwell Alive and well Danger signs Date of Death: Place of Death: Date of Delivery: Delivery Details Place of Delivery: Follow-up Tasks<I class="fa fa-flag"></i> The following tasks will appear: Please conduct a danger sign follow-up in 3 days. Please conduct a baby danger sign follow-up in 3 days. Mom is alive and unwell Convulsions Fever Severe headache Vaginal bleeding Foul smelling vaginal discharge <h2 style="text-align:center;margin-bottom:0px;"></h2> <p style="text-align:center;"> years old</p> Please continue to refer the woman to the health facility at the appropriate time. 24 hours 3 days 6 weeks 7 days None PNC Visits Additional PNC visits completed: PNC visits completed so far: Pregnancy Outcome<i class="fa fa-user"></i> Refer to clinic immediately for: Danger signs Referrals<I class="fa fa-hospital-o"></i> <h4 style="text-align:center;">To finish, be sure to click the Submit button.</h4> Patient<i class="fa fa-user"></i> The WHO recommends routine PNC visits at 24 hours, 3 days, 7 days, and 6 weeks from the date of delivery. Woman's Condition Death 0 1 2 3 Other 1 2 3 Other Skilled health care provider Traditional birth attendant Other I don't know Length in cm I don't know Weight in grams Alive and well Alive and unwell Alive and well Alive and unwell Deceased Male Female Vaginal Cesarean Health facility Home Other Within 24 hours (check this box if facility delivery) 3 days 7 days 6 weeks None of the above the woman Woman BCG only Birth Polio only BCG and Birth Polio None Yes No - - - - - - - - - - . ../../../../delivery_outcome/delivery_date ../../baby_death_date "Deceased baby" - - - "undefined" "person" - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - "xml" - . ../../../../../death_info_woman/woman_death_date ../../../../../death_info_woman/woman_death_add_notes ../../../../../death_info_woman/woman_death_place ../../../../../death_info_woman/woman_death_place - ../../../../inputs/contact/_id ../../../../inputs/contact/_id - "death_report" ../../../inputs/contact/parent/parent/contact/phone "data_record" - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TRUE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TRUE selected(../../condition/woman_outcome, 'deceased') - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - /delivery - - - - - - - hidden hidden hidden - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - /delivery - - - - - - - - - - - - - hidden - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - db-object - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - user <_id/> 0 <_id/> <_id/> <_id/>
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